Infants with antenatal exposure to selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs)
- Donna Stewart, CM, MD, FRCPC
Donna Stewart, CM, MD, FRCPC
- University Professor of Psychiatry, Ob-Gyn, Medicine, Surgery, Anesthesia, and Family and Community Medicine
- University of Toronto and University Health Network
- Simone Vigod, MD, MSc, FRCPC
Simone Vigod, MD, MSc, FRCPC
- Assistant Professor of Psychiatry
- University of Toronto
- Section Editors
- Peter P Roy-Byrne, MD
Peter P Roy-Byrne, MD
- Editor-in-Chief — Psychiatry
- Section Editor — Depressive Disorders
- Professor of Psychiatry and Behavioral Sciences
- University of Washington School of Medicine
- Joseph A Garcia-Prats, MD
Joseph A Garcia-Prats, MD
- Section Editor — Neonatology
- Professor of Pediatrics
- Baylor College of Medicine
Depressive disorders and anxiety disorders occur in approximately 10 to 15 percent of pregnant women, and can have short- and long-term deleterious effects upon the mother, child, and family [1-5]. Although patients with mild to moderate illness may respond to psychotherapy, patients with severe (eg, suicidality or psychosis), chronic, or recurrent syndromes often require pharmacotherapy.
The decision to prescribe antidepressants for pregnant patients requires clinicians to weigh the negative impact of untreated mood and anxiety disorders against the adverse effects of antidepressants. Although the risks to infants from antenatal exposure to selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) appear to be small, the potential risks are uncertain due to the lack of high quality data on the impact of these drugs. The complexity of managing pregnant women with mood and anxiety disorders requires coordinated efforts among psychiatrists, primary care clinicians, obstetricians, and pediatricians.
Maternal use of SSRIs and SNRIs during pregnancy and breastfeeding is estimated at 8 percent . SSRIs and SNRIs are first- and second-line medications for depressive and anxiety disorders, as well as other disorders such as obsessive-compulsive disorder and posttraumatic stress disorder. In addition, these antidepressants are often combined with lithium, valproate, carbamazepine, and second-generation antipsychotics for treating bipolar depression.
This topic reviews antenatal exposure to SSRIs and SNRIs and its effects upon infants. The clinical features and consequences of depression in pregnant women, treatment of antenatal and postpartum depression, the risks of antidepressants during pregnancy, and the use of psychotropic medications in breastfeeding mothers are discussed separately.
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- INTERPRETING THE EVIDENCE
- Study design
- - Confounding factors
- Differences among antidepressants
- PREGNANCY OUTCOMES
- NEONATAL EFFECTS
- Poor neonatal adaptation
- Persistent pulmonary hypertension of the newborn
- LONG TERM POSTNATAL DEVELOPMENT
- Intelligence, language, and behavior
- Motor skills
- Psychiatric symptoms and disorders
- - Autism